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NPI Code Detail

MEDICARE: SOUTHERN HEALTH CORP. OF HOUSTON, INC.

MEDICARE: SOUTHERN HEALTH CORP. OF HOUSTON, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center12-296MS

General Provider Information

NPI Number : 1003096488
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN HEALTH CORP. OF HOUSTON, INC.
Provider Business Mailing Address
First Line : PO BOX 626
Second Line :
City : HOUSTON
State : MS
Zip : 38851-0626
Country : US
Telephone Number : 662-456-1163
Fax Number : 662-456-1159
Provider Business Practice Location Address
First Line : 1002 E MADISON ST
Second Line :
City : HOUSTON
State : MS
Zip : 38851-2417
Country : US
Telephone Number : 662-456-1163
Fax Number : 662-456-1159
Authorized Official
Title or Position : CEO
Name : MS. SHEILA BROCKMAN
Credential :
Telephone Number : 662-456-3700
Provider Enumeration Date : 11/14/2007
Last Update Date : 01/18/2024

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Directions to “SOUTHERN HEALTH CORP. OF HOUSTON, INC. ” Practice Location

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